Centers for Disease Control and Prevention (CDC) Update Declaration of World Wide Pandemic Alert Level to Phase 6

[Guest guest]

Dear

Colleagues

While

it might feel that the issues related to H1 N1 are subsiding…this email from

CDC raises the current level to 6 and declares that a global pandemic is

underway.  Please see below.

Any

feedback that you would like to send to me individually should be directed to

me at Ryder@....

Bobbi

Bobbi Ryder

President & CEO

National Center for Farmworker Health, Inc.

1770 FM 967

Buda, TX

(512) 312-5453 direct line

(512) 312-5451 Mendoza , Assistant

(512) 312-2600

www.ncfh.org

From: Centers for Disease

Control & Prevention [mailto:cdc@...]

Sent: Thursday, June 11, 2009 12:07 PM

ryder@...

Subject: Centers for Disease Control and Prevention (CDC) Update

Attached are

updated notes from CDC related to the WHO Declaration of Pandemic Influenza

Phase 6.

On June 11,

2009, the World Health Organization (WHO) raised the worldwide pandemic

alert level to Phase 6.

Designation of

this phase indicates that a global pandemic is underway.

·

There are now

community level outbreaks ongoing in other parts of the world.

·

State and

international borders don’t matter at this point. The bottom line is that this

new virus is among us all.

·

While U.S.

influenza surveillance systems indicate that overall flu activity is decreasing

in the United States, novel H1N1 outbreaks are ongoing in different parts of

the U.S., in some cases with intense activity.

·

In the United

States, this virus has been spreading efficiently from person-to-person since

April and, as we have been saying for some time, we do expect that we will see

more cases, more hospitalizations and more deaths from this virus.

·

Because there

is already widespread novel H1N1 disease in the United States, the WHO Phase 6

declaration does not change what the United States is currently doing to keep

people healthy and protected from the virus.

·

Thus there is

no change to CDC’s recommendations for individuals and communities.

·

WHO’s decision

to raise the pandemic alert level to Phase 6 is a reflection of epidemiological

changes in other parts of the world and not a reflection of any

change in the novel H1N1 virus or associated illness.

·

At this time,

most of the people who have become ill with novel H1N1 in the United States

have not become seriously ill and have recovered without hospitalization.

·

In the United

States, we have been preparing for this for some time.

·

And we are

actively and aggressively implementing our pandemic response plan.

Phase

6 is an indicator of spread and not of severity.

·

It’s uncertain

at this time how serious or severe this novel H1N1 pandemic will be in terms of

how many people infected have severe complications or death related to novel

H1N1 infection.

There were

three influenza pandemics in the last century and they varied widely in

severity.

The 1918

pandemic killed tens of millions of people.

The 1957

pandemic is thought to have resulted in at least 70,000 deaths in the United

States.

Deaths from

the 1968-69 pandemic were about the same as for seasonal influenza.

This pandemic

certainly poses the potential to be at least as serious as seasonal flu,

if not more so.

Because this

is a new virus, many people will not have immunity to it and illness may

be more severe and widespread as a result.

We are still

learning about this virus and expect that, like all influenza viruses, it

will continue to change.

There are some

encouraging signs:

o

So far we have not seen an extensive pattern of very severe

illness related to this virus.

o

Results

of a serology study conducted by CDC suggest that some adults may have some

degree of preexisting cross-reactive antibody to the novel H1N1 flu virus,

especially adults older than 60.

o

And, this virus does not have the genetic markers for virulence

that we saw in the 1918 pandemic virus, or that we see today in the H5N1 virus

in Asia that has been lethal among people.

· But

it’s early days and too soon to predict what will happen.

·

It is important to remember that the potential remains for the

virus to change and cause more severe disease.

·

The real

uncertainty is the fall and how the novel H1N1 virus will affect the 2009-2010

influenza season in the United States.

·

We are still

learning about the severity and other epidemiological characteristics of the

novel H1N1 virus.

·

This

information is important and will be taken into account when making

recommendations with regard to vaccine and other preventive measures in the

fall.

·

CDC will update its guidance and recommendations as more

information about the novel H1N1 flu virus becomes available.

· It will

be important that we continue to watch this virus carefully.

· The

Southern Hemisphere is just going into their flu season and how this virus

behaves will give us some clues about what we can expect for the Northern

Hemisphere.

· The

situation is indeed sobering, but it’s important to keep in mind that we are

not helpless.

We are taking action:

The Federal

Government is mounting an aggressive response to this newly declared

pandemic.

CDC’s goals

during this public health emergency are to reduce transmission and illness

severity, and provide information to assist health care providers, public

health officials and the public in addressing the challenges posed by this

newly identified influenza virus.

To

this end, CDC continues to update guidance.

Visit

the CDC website at http://www.cdc.gov/h1n1flu/ for more

information or call 1-800-CDC-INFO.

·

Everyday, we

learn more about this virus and what we learn will continue to inform the

actions that we take in response.

·

We are

aggressively taking early steps in the vaccine manufacturing process, working

closely with manufacturing and the rest of the government.

·

Vaccines are a

very important part of a response to pandemic influenza.

·

CDC isolated

the new H1N1 virus, made a candidate vaccine virus, and has provided this virus

to industry so they can begin scaling up for production of a vaccine, if

necessary.

·

There are many

steps involved with producing a vaccine and we are committed to going forward

with the NIH, and FDA, BARDA, and the manufacturers of influenza vaccines, to

see about developing full scale vaccine production.

·

Where possible,

we are taking parallel steps to speed up the vaccine process.

If

things go well, and we develop a full scale production, it would be

several months until the vaccine were available.

So

vaccine is an important tool for the future.

Public:

So

far, most people who have been ill with this virus have recovered.

We

are monitoring hospitalization and death rates.

At

this point, whether you are tested and actually diagnosed with novel H1N1

is less important than what you do if you become sick.

It’s

possible that this summer, people around you may get sick and you may get

sick.

Certainly

in the fall, with our flu season, people around you will be getting sick

and you may get sick.

Be

prepared to stay home for a week or so if you are ill.

Most

people infected with this virus so far have experienced the regular

symptoms of flu (fever, cough, body aches + a significant number of people

have reported vomiting and diarrhea).

For

people who are critically ill, we do have antiviral medications in our

arsenal against flu.

The

priority use for influenza antiviral drugs at this time is to treat severe

influenza illness.

·

Influenza

antiviral drugs are prescription medicines (pills, liquid or an inhaler) with

activity against influenza viruses, including swine influenza viruses.

·

There are two

influenza antiviral medications that are recommended for use against swine

influenza. These are oseltamivir (trade name Tamiflu ® and zanamivir (Relenza

®).

·

Influenza

antiviral drugs work best when stated soon after illness onset (within two 2

days), but treatment with antiviral drugs should still be considered after

48 hours of symptom onset, particularly for hospitalized patients or people at

high risk for influenza-related complications.

·

You have a role

in protecting yourself and your family.

Stay informed.

Health officials will provide additional information as it becomes

available. Visit www.cdc.gov

Everyone

should take these everyday steps to protect your health and lessen the

spread of this new virus:

Cover

your nose and mouth with a tissue when you cough or sneeze. Throw the

tissue in the trash after you use it.

Wash

your hands often with soap and water, especially after you cough or

sneeze. Alcohol-based hand cleaners are also effective.

Avoid

touching your eyes, nose or mouth. Germs spread this way.

Try

to avoid close contact with sick people.

If you are sick with a flu-like illness, stay home for

7 days after your symptoms begin or until you have been symptom-free for

24 hours, whichever is longer. This is to keep from infecting others

and spreading the virus further.

Follow public

health advice regarding school closures, avoiding crowds and other social

distancing measures.

If you don’t

have one yet, consider developing a family emergency plan as a

precaution.

Pandemic Severity, General

·

Influenza

pandemics can range in severity, mainly in terms of the number of people that

have severe illness and die.

·

Pandemic

severity may also change over time and will differ across regions of the world,

in different countries and even within different communities within a country.

·

Pandemic

disease severity will vary depending on several factors: a nation’s ability to

provide health care to their people, the availability of antiviral medications

to treat those who are sick, differences in how the disease affects people in

different age groups, and the effectiveness of efforts to reduce

person-to-person transmission of influenza.

·

An

evaluation of pandemic severity should be based on local circumstances for this

reason.

·

A

pandemic severity index helps pubic health officials to match the timing of the

spread and severity of the outbreak with the appropriate use of public health

and community resources to minimize the number of people who get sick and the

number of people who die. 

U.S. Pandemic Severity Index (PSI)

CDC developed

the U.S. Pandemic Severity Index (PSI) to describe the severity of a

pandemic in terms of illness and death.

The U.S. PSI

scale is based on the case-fatality ratio; the likelihood of people dying

from the disease.

The PSI scale

ranges from Category 1 to Category 5 and is comparable to the U.S.

hurricane severity index.

Category 1 is

the least severe and Category 5 is the most severe.

·

At the current

time, CDC estimates that the pandemic situation in the U.S. would be equivalent

to a pandemic severity index of 2. (This would be most similar to the 1957 influenza pandemic,

however, it’s uncertain how the current situation will

evolve over the coming months so it’s not possible to make a predication about

deaths at this time.)

CDC

will re-evaluate the classification of the Pandemic Severity Index should

there be evidence that the pandemic has become more severe.

The

PSI will be adjusted based on that evaluation and appropriate guidelines

and recommendations provided.

CDC emphasizes that unnecessary weight

not be given to the numeric categorization of the pandemic.

According

to the U.S. PSI:

A category 1

pandemic has the following:

Case

fatality ratio of less than 0.1 percent

Excess death

rate of less than 30 per 100,000 people

Illness rate

of 20-40% of the population

Less than

90,000 potential deaths (based on 2006 U.S. population)

Similar to a

more severe seasonal flu year in the United States

A category 2

pandemic has the following:

§

Case

fatality ratio of 0.1 percent to less than 0.5 percent.

§

Between

90,000 and 450,000 deaths in the U.S. (based on 2006 U.S. population)

§

Excess

death rate of between 30 to less than 150 per 100,000 people

§

Illness

rate of between 20 and 40 percent.

§

Similar

to 1957 pandemic.

A category 5

pandemic has the following:

Case

fatality ratio of greater or equal to 2 percent

Excess death

rate of more than 600 per 100,000 people

Illness rate

of 20-40% of the population

Greater than

or equal to 1.8 million potential deaths (based on 2006 U.S. population)

Similar to

the 1918 pandemic

The importance of identifying a

category of severity is only to help guide the public health interventions

recommended for individuals and communities.

The PSI scale

helps public health officials match the range of public health

intervention efforts to the severity of a pandemic.

For

a Category 1 to 3 pandemic:

Ill adults

and children are asked to stay home voluntarily.

If someone

in the household is sick, well adults and children do not need to

stay at home.

School and

child care dismissal is not generally recommended, but may be considered

depending on the local impact of the disease.

Workplace and Community adult social distancing

efforts (e.g., encouraging teleconferences instead of meetings, reducing

density, meaning the number of people crowded into an enclosed space, in

public transit and the workplace, postponing or canceling selected

public gatherings, encouraging people to telework, or take staggered

shifts) are generally not recommended.

For a

Category 4 to 5 pandemic

Ill adults

and children are asked to stay home voluntarily.

If someone

in the household is sick, well adults and children should stay at home

too.

School and

child care dismissal is recommended for up to 12 weeks.

Workplace and Community adult social distancing

efforts (e.g., encouraging teleconferences instead of meetings, reducing

density, meaning the number of people crowded into an enclosed space, in

public transit and the workplace, postponing or canceling selected

public gatherings, encouraging people to telework, or take staggered

shifts) are recommended

Declaration of Phase 6 and Travel

At this time,

CDC does not recommend against travel to any country.

CDC will

continue to monitor the H1N1 situation around the world and will provide

recommendations to U.S. travelers based on the changing situation.

Travelers

should check the CDC travelers’ health website (www.cdc.gov/travel) for

information related to this outbreak, as well as for health information on

the prevention and management of flu.

Travelers

should also check the website of the embassy of the country to which they

are traveling for the latest updates on entry or exit screening procedures

which may impact their travel.

CDC recommends

that ill persons postpone travel both for their protection and that of

other travelers.

WHO Phases

·

The

World Health Organization (WHO) has developed a plan to be prepared for a

global outbreak of influenza to help countries to protect the public’s health

before and during a pandemic. 

·

This

plan defines the “phases” of a pandemic which describe the global risk for a

pandemic and the extent of global spread.

·

The

WHO phases provide a benchmark to guide national preparedness and planning for

a pandemic, and helps to indicate when countries should shift to response and

mitigation efforts.

·

The

WHO phases are:

o

Phase

1:

No new influenza virus subtypes have been detected in humans. An influenza

virus subtype that has caused human infection may be present in animals. If

present in animals, the risk of human infection or disease is considered to be

low.

o

Phase

2:

No new influenza virus subtypes have been detected in humans. However, an

animal influenza virus circulating among domesticated or wild animals is known

to have caused infection in humans and poses a substantial risk of human

disease.

o

Phase

3:

An animal or human-animal influenza reassortant virus has caused sporadic cases

or small clusters of disease in people, but has not resulted in human-to-human

transmission sufficient to sustain community-level outbreaks. Human

infection(s) that occur with this new subtype occur with at most rare inst

ances of human-to-human spread, or spread to a close contact.

o

Phase

4:

Small cluster(s) of human infections with limited but verified human-to-human

transmission. The spread is highly localized, suggesting that the virus is not

well adapted to humans. However, the virus has the potential to cause

“community-level outbreaks.

o

Phase

5:

There is human-to-human spread of the virus into at least two countries in one

WHO region. Most countries are not affected but there are larger though

localized cluster(s) of human infections due to human-to-human spread. These

changes  suggest that the vir us is becoming increasingly better adapted to

humans. There is a substantial pandemic risk.

o

Phase

6:

The pandemic phase. There is increased and sustained transmission with

community level outbreaks in at least one other country in a second WHO region.

This phase indicates that a global pandemic is under way.

WHO Phase 6 Declaration 

•   The World Health

Organization (WHO) has declared Pandemic Phase 6; that this outbreak of

influenza is a pandemic, which means that the current novel H1N1 flu which is

spreading involves sustained human-to-human transmission in two or more regions

of the world.

•   Because there is already

widespread novel H1N1 flu virus disease in the United States, the WHO Phase 6

declaration does not change what the United States is currently doing to keep

people healthy and protected from the virus.

· Thus

there is no change to CDC’s recommendations for individuals and communities.

•   CDC’s initial

recommendations were aimed at preventing and minimizing illness and death in

light of uncertainty about the how severe novel H1N1 flu would be.

•   It is important to remember

that the potential remains for the virus to change and cause more severe

disease.

CDC will

update its guidance and recommendations as more information about the

novel H1N1 flu virus becomes available.

Significance of WHO Phase 6

Declaration – [Moderate] Severity Index

WHO has a

three point scale to determine pandemic severity – mild, moderate and

severe.

At this time,

WHO has indicated this seems to be a moderately severe pandemic.

The WHO

severity index advises countries about the possible impact on health and

other related issues as a result of the current novel H1N1 flu

outbreak.   

Similar to how

on any given day the weather pattern and the severity of weather will

differ from country to country around the world and even within a country,

the novel H1N1 flu pandemic will affect countries and communities in

different ways.

•   The effects of the novel

H1N1 flu pandemic will not be the same for all countries, and countries may not

experience effects at the same time. 

Transmission

of the novel H1N1 virus from person to person will affect countries at

different times of the year but also in different locations within these

countries.

The potential

health effects of the influenza pandemic will differ depending on several

factors: a nation’s ability to provide health care to their people, the

availability of antiviral medications to treat those who are sick,

differences in how the disease affects people in different age groups, and

the effectiveness of efforts to reduce person-to-person transmission of

influenza.

As

understanding of the novel H1N1 virus becomes clearer over time, the WHO

recommendations may change.  CDC will remain flexible in order to respond

in the best way possible to the changing situation and provide updated

guidance as more information becomes available.

Modify/Update

Email Preferences | Unsubscribe

| Send

Feedback | Learn

more about CDC Email Updates

To receive the latest news for your region, please update your

profile with your country, state and zip code.

Questions or problems? Please contact support@....

Centers for Disease Control and Prevention (CDC) ·

1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)